Joyce James J, Chang Ruey-Kang R, Qi Ning, Owens Twyman R, Ginzton Leonard E, Baylen Barry G
Cardiology Division, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Echocardiography. 2004 Jan;21(1):17-25. doi: 10.1111/j.0742-2822.2004.02155.x.
The effects of chronic volume or pressure overload on the velocity of right ventricular ejection have not been previously well defined. We hypothesized that, as formerly shown for the left ventricle, there would be a direct relationship between the velocity of ejection and an estimate of systolic wall stress.
Echocardiograms of asymptomatic patients, not on cardiac medications, with either an isolated secundum atrial septal defect > or = 5 mm in diameter or isolated pulmonic stenosis with a peak instantaneous pressure gradient > or = 20 mmHg, were reviewed. Forty-one patients with an atrial septal defect and 34 with pulmonary stenosis met criteria, and were compared to age-matched normal controls. Total subjects were 127 with ages ranging from 1 day to 54 years. Right ventricular monoplane ejection fraction, ejection time corrected for heart rate (ETc), mean normalized systolic ejection rate (MNSERc) and meridianal peak-systolic wall stress (WSps) were measured.
Compared to controls, ejection fractions were not significantly different, but WSps averaged 81% and 110% higher, ETc 8% and 9% longer, and MNSERc 5% and 9% slower in the atrial septal defect and pulmonary stenosis groups, respectively. Among all subjects WSps had a significant linear correlation with ETc (r = 0.61, P < 0.01), MNSERc (r =-0.46, P < 0.01), and ejection fraction (r =-0.19, P < 0.05).
Increases in WSps cause an incremental slowing of MNSERc in the right ventricle, with a relationship that is linear over a wide range of normal and abnormal loading conditions.
慢性容量或压力超负荷对右心室射血速度的影响此前尚未明确界定。我们推测，如先前在左心室中所显示的那样，射血速度与收缩期壁应力估计值之间存在直接关系。
回顾了未服用心脏药物的无症状患者的超声心动图，这些患者患有直径大于或等于5毫米的单纯继发孔型房间隔缺损或峰值瞬时压力梯度大于或等于20毫米汞柱的单纯肺动脉狭窄。41例房间隔缺损患者和34例肺动脉狭窄患者符合标准，并与年龄匹配的正常对照组进行比较。总共有127名受试者，年龄范围从1天到54岁。测量了右心室单平面射血分数、经心率校正的射血时间（ETc）、平均标准化收缩期射血率（MNSERc）和子午线峰值收缩期壁应力（WSps）。
与对照组相比，射血分数无显著差异，但房间隔缺损组和肺动脉狭窄组的WSps平均分别高出81%和110%，ETc分别长8%和9%，MNSERc分别慢5%和9%。在所有受试者中，WSps与ETc（r = 0.61，P < 0.01）、MNSERc（r = -0.46，P < 0.01）和射血分数（r = -0.19，P < 0.05）均存在显著线性相关。
WSps的增加导致右心室MNSERc逐渐减慢，在广泛的正常和异常负荷条件下，这种关系呈线性。
